{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T06:01:39Z","timestamp":1776837699481,"version":"3.51.2"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,2,3]],"date-time":"2016-02-03T00:00:00Z","timestamp":1454457600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>To assess clinical characteristics, pharmacotherapy treatment patterns, resource utilization and associated charges, and morbidity and mortality outcomes among a real\u2010world cohort of patients with heart failure with reduced ejection fraction (<jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>r<jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>) in an academic medical center setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Source<\/jats:title><jats:p>Electronic health record database that includes clinical, laboratory, and administrative data for all facilities of the University of Utah Health Care System.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>A total of 989 adults with prevalent (preexisting) <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>r<jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>, identified by using the <jats:italic>International Classification of Diseases, Ninth Revision, Clinical Modification<\/jats:italic> code 428.x (heart failure) between January 1, 2007, and June 30, 2013, and who had a left ventricular ejection fraction of 40% or lower.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>The cohort had a mean age of 64 \u00b1 15 years and was predominantly white (71%) and male (74%). Patients received \u03b2\u2010blockers, angiotensin\u2010converting enzyme inhibitors (<jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content>s) or angiotensin <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> receptor blockers (<jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content>s), and aldosterone receptor antagonists (<jats:styled-content style=\"fixed-case\">ARA<\/jats:styled-content>s) at rates of 79%, 69%, and 29%, respectively. Patients achieved target doses of \u03b2\u2010blockers, <jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content>s, and <jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content>s at rates of only 24%, 31%, and 13%, respectively. Overall, 58% of patients were prescribed dual therapy with a \u03b2\u2010blocker and an <jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content>, and 19% were prescribed triple therapy (\u03b2\u2010blocker, an <jats:styled-content style=\"fixed-case\">ACEI<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">ARB<\/jats:styled-content>, and an <jats:styled-content style=\"fixed-case\">ARA<\/jats:styled-content>). Univariate and multivariate logistic regression models were used to assess the association between baseline characteristics with the presence of triple therapy. Two variables were statistically significant in both models: increasing age was associated with a lower odds of triple therapy (univariate: odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 0.760, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 0.673\u20130.857; multivariate: <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.768, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.625\u20130.942), whereas receipt of an implantable cardiac device was associated with a 2\u2010fold increase in the odds of triple therapy (univariate: <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.1, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.4\u20133.1; multivariate: <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.1, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.3\u20133.5). During a mean \u00b1 <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> follow\u2010up of 36 \u00b1 27 months, all\u2010cause mortality was 0.12 per person\u2010year. There were 1311 all\u2010cause hospitalizations of which 611 (47%) were for worsening heart failure. The rate of all\u2010cause and heart failure\u2013specific hospitalizations was 0.44 and 0.21 per person\u2010year of follow\u2010up, respectively. The median length of stay was 6.4 \u00b1 8.8 days, and the median charge was $22,310. The 30\u2010day all\u2010cause readmission rate was 20%, and the primary reason for readmission was heart failure in 65% of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates the continuing significant disease and economic burden for patients with <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>r<jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>. Challenges remain in utilization of established disease\u2010modifying therapy and in the treatment of patients with <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>r<jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content> and multiple comorbidities.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.1701","type":"journal-article","created":{"date-parts":[[2016,2,3]],"date-time":"2016-02-03T11:41:58Z","timestamp":1454499718000},"page":"174-186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Pharmacotherapy Treatment Patterns, Outcomes, and Health Resource Utilization Among Patients with Heart Failure with Reduced Ejection Fraction at a U.S. Academic Medical Center"],"prefix":"10.1002","volume":"36","author":[{"given":"Adam P.","family":"Bress","sequence":"first","affiliation":[{"name":"Department of Pharmacotherapy University of Utah Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan B.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy University of Utah Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Brixner","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy University of Utah Salt Lake City Utah"},{"name":"Program in Personalized Health University of Utah Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Kielhorn","sequence":"additional","affiliation":[{"name":"Amgen Inc. Thousand Oaks California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harshali K.","family":"Patel","sequence":"additional","affiliation":[{"name":"Amgen Inc. Thousand Oaks California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Maya","sequence":"additional","affiliation":[{"name":"Amgen Inc. Thousand Oaks California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinson C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Amgen Inc. Thousand Oaks California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Biskupiak","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy University of Utah Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Munger","sequence":"additional","affiliation":[{"name":"Amgen Inc. 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